Initiative 1000 becomes Washington's Death With Dignity Act (DWDA) on March 4, giving physicians the right to assist terminally ill patients to end their lives with a lethal prescription. As the deadline nears for putting the controversial law into effect, much of the uncertainty centers on whether medical institutions opposed to it can prevent associated health providers from participating.
Those raising the issue are primarily Catholic-associated hospitals and hospices that are morally opposed to the principle of the DWDA. Some of the larger ones, such as PeaceHealth in Bellingham and Longview and Providence Health and Services in Spokane, are the largest health providers in their communities.
PeaceHealth in November announced it would not participate in the DWDA, and would prohibit its employees, including doctors, from participating or from referring patients to doctors who would participate. In communities where such opt-out organizations are the dominant health-care providers, the worry is that the law, passed by a large margin, would be negated.
Not likely, says the Oregon attorney who drafted both the Oregon and Washington laws, and was involved in the legal battles that engulfed Oregon's law after its passage by initiative in 1994. The policy is simple, Eli Stutsman told Crosscut: "Those who are opposed [to DWD] should not be forced to participate, nor should those who want to participate be precluded from participation."
In Oregon, says Stutsman, the prospect of hospitals or hospices barring their employees from participation is "a non-issue" because there are so many other alternatives, even in small communities with dominant facilities who are opting out.
Non-participants, such as PeaceHealth, can only deny participation to its direct employees, Stutsman notes, with agreement from PeaceHealth's Ross Fewing, director of spiritual care for PeaceHealth in Whatcom County, where PeaceHealth employs about 97 of the county's estimated 400 physicians and operates the only hospital. Stutsman and Fewing both say that a doctor who simply has hospital privileges does not lose the right to participate in DWDA. Nor does the prohibition cause serious problems for hospice care administered by non-participants, because most hospice care takes place in patients' homes or private facilities.
Stutsman believes that the Oregon law, the nation's first, introduced a community conversation on end-of-life issues that was new and refreshing. Advocates, he adds, are available in most communities to work with those who want to explore the DWDA, and referrals to cooperating doctors are part of their service. Although Washington's medical association opposed the initiative that established Washington's law, the views among individual doctors are, not surprisingly, mixed. In this way, the state's doctors will be right in line with Oregon's physicians.
In Oregon 2008, the 85 prescriptions written for end-of-life use were written by 45 different doctors. Forty of the 341 Oregonians who used the law since its inception were under the care of a Catholic health-care system or a physician working in one, George Eighmey of Compassion and Choices of Oregon, told the Seattle Times.
Oregon had to overcome hurdles that are unlikely in Washington. An effort to repeal the measure was defeated at the polls, and an effort by the Bush Administration to negate the law was struck down by the U.S. Supreme Court. Once Oregon's DWDA actually went into effect in 1997, it proved to be less dramatic than opponents expected, and today seldom makes its way into the news.
Fewing, a medical ethicist, believes conflicts over the law are not as sharp as they might initially appear. "We will never abandon a patient, nor will we dictate what a patient and his or her doctor can talk about," he emphasized to Crosscut. The underlying but unspoken message is that, as in Oregon, ways will be found to connect a patient to a physician willing to participate in the DWDA. Counselors and assisted-death advocates will be that link in most cases.
Medical historians and ethicists have long known of the underground practice by some physicians who provide medicine to patients facing imminent death and who wish to terminate a life that has become untenable. The Hastings Center, a nonpartisan institute dedicated to research in bioethics, notes in its handbook on physician-assisted death:
In circumstances of intractable patient suffering, there is evidence that physicians in the United States sometimes assist in patients' deaths. This is not an easy subject for empirical research because to admit participation, a physician must admit to a crime. Nonetheless, several very imperfect studies of the practice in the United States suggest that in the majority of jurisdictions where physician-assisted death is illegal, it accounts for approximately 1-2% of deaths. In contrast, physician-assisted death is less common in Oregon, where for 10 years it has been legal for terminally ill patients who experience unacceptable suffering. Data collected by the Oregon Health Department show that the practice is stable and relatively rare, accounting for approximately one in 1,000 deaths.
Like much surrounding physician-assisted death, those statistics can be debated and used by opposing sides. But if the Oregon experience is any indicator — and it's the only experience we can draw from — the debate will not bar this from becoming accepted practice here. This practice will always have its vocal opponents, but it is not likely that those medical professionals and institutions who chose to participate will be stigmatized for participation.
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